左束支末端在复发性左室特发性室速发生中的作用及左束支末端消融治疗的可行性

Feasibility of the role of the end of the left bundle branch in the recurrence idiopathic left ventricular tachycardia, the feasibility of the ablation at the end of the LBB

目的：评价左束支末端（LBB）在复发性左室特发性室速发生中的作用及在左束支末端消融治疗的可行性。方法3例复发的左室特发性室速患者（男2例,女1例）均接受至少2次射频消融治疗（包括三维标测指导下的消融）。其中2例（均为男性）复发室速 ECG 的 QRS 波形态发生改变,即右束支传导阻滞并电轴右偏。行心内电生理检查,窦律下和室速发作时,在左束支末端分别标测 H-LBB 间期、H-V 间期及 LBB-DP 间期,并行起搏拖带检查。之后在左束支末端行射频消融治疗。结果窦性心律下标测 H-LBB 间期为（36.0±1.0）ms,H-V 间期为（72．7±1.2）ms,LBB-DP 间期为（296.7±78.2）ms。室速发作时,标测 H-LBB 间期为（-32.0±2.0）ms,H-V 间期为（31.3±1.2）ms,LBB-DP 间期为（290.7±73.1）ms。在左束支末端均可成功起搏拖带心室,室速发作时,标测起搏后间期为（414.3±6.5）ms。消融治疗后,H-LBB 间期为（36.0±1.0）ms,H-V 间期为（73.7±1.5）ms,LBB-DP 间期（579.0±6.6）ms。结论左束支末端参与了复发性 ILVT 的折返形成,并且发挥了重要作用,在左束支末端行导管消融可成功终止 ILVT 的反复发作。

Objective To evaluate the feasibility of the role of the end of the left bundle branch in the recurrence idiopathic left ventricular tachycardia（ILVT）, the feasibility of the ablation at the end of the LBB. Methods Three pa-tients with recurrence ILVT who accepted twice RFCA at least（including by use CARTO or ENSITE 3000）, 2 patients with a changed VT morphology-right bundle branch block with a inferior axis deviation. In sinus and the episode of VT, the H-LBB interval was mapped; the H-V interval and LBB-DP interval at the end of LBB was mapped. After then, at the end of the LBB was ablated. Results In sinus, the interval of H-LBB, H-V and LBB-DP was （36. 0 ± 1. 0）ms, （72. 7 ± 1. 2） ms and （296. 7 ±78. 2）ms, respectively. During the tachycardia, the interval of H-LBB, H-V and LBB-DP was （ -32. 0 ± 2. 0）ms, （31. 3 ±1. 2）ms and （290. 7 ±73. 1）ms, a successful entrainment at the end of LBB was obtained, and the post pacing interval was（414. 3 ± 6. 5）ms. After the ablation, the interval of H-LBB, H-V and LBB-DP was （36. 0 ± 1. 0）ms, （73. 7 ± 1. 5）ms and （579. 0 ± 6. 6）ms. Conclusions The end of the LBB plays an important role in the reentry circuit of the recurrence ILVT, and ablation at the end of the LBB can cure the ILVT.